Prioritization

Lebanon seeks to vaccinate 80 percent of the total population. This includes both citizens and non-citizens residing in Lebanon. The NCC technical group assumed the task of identifying high-risk population to receive the COVID-19 vaccines given the doses reserved for Lebanon (either via COVAX or bilateral agreement) and possible shortages in supply worldwide. Vaccine distribution by priority will depend on evidence-based criteria to pinpoint those at risk of severe infection or exposure. Distribution will be subject to several variables including supplies, type of vaccines, public acceptance and the logistics associated with introducing mass vaccination.

As Lebanon is currently in COVID-19 community transmission level 4, and given the limited but gradually increasing supply categorized as Stage II-III according to WHO (10 percent-35 percent), initial focus will be on reduction of morbidity and mortality, maintenance of most critical essential services and reciprocity. Depending on the availability of vaccine, selection will then be expanded to focus on reduction in transmission to further reduce disruption of social and economic functions. A risk-and age-based approach for prioritization of COVID-19 vaccine target groups will be adopted with the aim of ensuring just, efficient, and timely vaccine distribution to all eligible candidates willing to be immunized based on:

 The WHO SAGE values framework;

 The WHO SAGE prioritization roadmap;

 The fair allocation mechanism for COVID-19 vaccines through the COVAX Facility Accordingly, Lebanon prioritizes the high-risk populations through a multi-phase roll-out plan.

Phases 1 and 2 represent the first 35 percent of the total population (both citizens and non-citizens) to be vaccinated in 2021. The stages 3 and 4 will cover the rest of the targeted population. Vaccination to

23 priority populations (Table 4) will be managed in an inclusive and non-discriminatory manner (including outreach activities to vulnerable groups, such as refugees).

Industrial sectors will be encouraged to secure the vaccine from the private sector once it is available to vaccinate their staff. This is essential to regain the economic cycle in the country.

Table 4. Estimated priority populations for COVID-19 vaccination in Lebanon

Phase Target population Population

size^[1]

Share of population*

First 35%^[2] High risk health workers 55,000 0.8%

Aged 65 and older 600,143 9.2%

Those below age 65 (55 – 64 years) but with comorbidities 237,183 3.6%

All those between ages 55-64 not covered earlier, 16-54 years with co-morbidities^[3],

health workers not covered earlier

237,183 1,150,671

5,000

3.6%

17.7%

0.1%

Persons and staff in elderly shelters, prisons, and individuals essential for preserving the essential function of the society (the national COVID-19 vaccination committee will define strict criteria to identify recipients of the latter group).

25,000 3.4%

Next 35%

Other vulnerable populations, schoolteachers and school staff**, childcare workers, other critical workers in high risk settings, remaining health care workers, family caregivers of those age ≥65 or with special needs, and all those above the age of 16 willing to be vaccinated

2,449,820 35%

*overlaps exist and sums do not add up

** School teachers and school staff are estimated to be around 120,000

[1] The total population considered for calculation is 6,800,000. This includes 5,999,958 Lebanese citizens and registered refugees and approximately 800,042 unregistered refugees and migrants.

[2] This includes Phases 1 and 2 while the remining 35% includes Phases 3 and 4.

[3]An estimated figure of 30% prevalence of Hypertension has been used to estimate the number of co-morbidities in the population 16-54. Findings of recent studies in Lebanon have showed that Hypertension affects approximately one-third of the Lebanese population. (D. Matar, A. H. Frangieh, S. Abouassi et al., “Prevalence, awareness, treatment, and control of hypertension in Lebanon,” The Journal of Clinical Hypertension, vol. 17, no. 5, pp. 381–388, 2015; The Lebanon STEPS 2017 database for NCD includes a prevalence of Hypertension of 35% in the age group 20-69 years.)

24 Sequential prioritization of HCWs:

 Frontline HCWs (ER personnel, ICU…);

 Medical, nursing and postgraduate students if involved in frontline healthcare;

 HCWs performing aerosol-generating procedures (e.g., intubation, cough induction procedures, bronchoscopies, some dental procedures and exams);

 Environmental HCWs in health care facilities (Infection control, cleaners and housekeepers);

 Healthcare or laboratory personnel collecting or handling specimens;

 Medical transport workers (e.g., ambulance vehicle operators, Red Cross);

 Mortuary workers involved in preparing (e.g., for burial or cremation) the bodies of people who are known to have COVID-19 and morgue workers performing autopsies;

 Physicians in private clinics (ID physicians, Pulmonologists);

 Midwives working outside hospitals;

 Physiotherapists;

 Community pharmacists;

 Dentists;

 PHCCs staff

Table 5. Healthcare workers categorization by risk of exposure Category 1

Operating Rooms (theaters) Administration COVID Units (ICU & Regular) Recovery Room Admitting officers Laboratory staff (COVID &

others)

Surgical ICU Billing department

Medical ICUs Coronary care units Security staff

Endoscopy Units Medical & surgical wards Central Sterile Department Dialysis Units Catheterization Labs and Auxiliary services

Oncology units Private clinics + OPDs Laundry

Delivery suite Physiotherapy

Radiology Department Dentists

House Keeping Pharmacists

Ambulance services Plant engineering

Home-care Incarceration centers HCWs

Inhalation therapy Shelters orphanages HCWs Nursing homes Dieticians & nutrition COVID-19 isolation and

Quarantine centers

Speech Therapy & Ergo therapists

COCIVD-19vaccination staff Psychologists

25 Table 6. Vaccine Prioritization among nurses

Very high risk High risk Medium risk Low risk

Emergency room Coronary care + telemetry units

Endoscopy unit Nursing faculties and technical schools ICU (COVID and

regular)

Medical surgical and pediatric

Operating room Insurance companies

NICU and PICU Dialysis Recovery room Medical companies

Inhalation therapy Home care nursing Administration

Cardiac surgical unit Long stay hospitals Regular COVID-19 ward Nurseries & schools Oncology + Palliative

care

Primary care centers COVID-19 Vaccination

team

Sequential prioritization of underlying medical conditions based on national epidemiological data on those at greater risk of requiring hospitalization or experiencing severe illness with possible poor outcome:

 Patients on dialysis;

 Cardiovascular diseases;

 Diabetes;

 Hypertension;

 Obesity (BMI of ≥40 Kg/m²);

 Cancer patients (particularly hematological malignancies, lung cancer, and metastatic disease);

 Chronic kidney disease and kidney transplant patients;

 Chronic obstructive lung disease (COPD – Asthma);

 Immunocompromised individuals for any reason (HIV/AIDS, TB);

 Other chronic illnesses (Neurological, rheumatologic diseases; i.e MS patients).

WHO and the U.S. FDA have issued an EUA to permit the emergency use of the unapproved product, Pfizer-BioNTech COVID-19 Vaccine, for active immunization to prevent COVID-19 in individuals 16 years of age and older. Accordingly, people under 16 years have been excluded for now and will be reviewed for inclusion later as more information on vaccine safety and efficacy among them become available.

This also applies for pregnant and lactating women.

MoPH has also decided that individuals who had a severe allergic reaction after a previous dose of this vaccine and individuals who had a severe allergic reaction to any ingredient of this vaccine will not be eligible for taking the COVID-19 vaccines.

Im Dokument Lebanon National Deployment and Vaccination Plan for COVID-19 Vaccines (Seite 22-25)